News News September 3, 2010

Working Conditions Similar at Magnet and Non-Magnet Hospitals

American Nurses Credentialing Center's Commission on Magnet Recognition recognizes healthcare organizations providing nursing excellence, but that does not necessarily mean better working conditions for nurses, according to a new study from researchers at the University of Maryland School of Nursing in Baltimore.

“While the work and role of nursing may be improved, because it is a Magnet hospital, we found that consideration of nurses’ work schedules is not really incorporated into the Magnet hospitals,” said Alison Trinkoff, ScD, RN, FAAN, a nursing professor at the University of Maryland and lead author of the paper published in the Journal of Nursing Administration.

The University of Maryland researchers compared schedules and working conditions in hospitals that have obtained Magnet status and those that have not and found they did not vary much. Nurses in Magnet facilities reported working less mandatory overtime and on-call time, but the hours they put in per day and per week was similar, as was nursing practice, a patient safety culture and overall job satisfaction.

The researchers found no difference in psychological demands reported by nurses in the two types of hospitals. Magnet hospital nurses said physical demands were lower than their peers, but the authors concluded that the difference was of little practical significance.

Karen Drenkard, PhD, RN, NEA-BC, FAAN, director of the Magnet Recognition Program® at the American Nurses Credentialing Center (ANCC), said that while “we are supportive of research and embrace all research, this study had some issues.” She raised concern about the age of the data, from the 2004 Nurses Worklife and Health Study, and that the hospitals studied had achieved accreditation status in 2005. Since 2008, ANCC has required Magnet facilities to report clinical outcomes and nurse and patient satisfaction. Drenkard expects a more current analysis would produce different results.

Linda Plank, PhD, RN, NEA-BC, a lecturer in nursing at the Baylor University Louise Herrington School of Nursing in Dallas, said she was surprised to hear about and read the article showing comparable working conditions in Magnet and non-Magnet hospitals, citing a number of published articles confirming that Magnet hospitals are desired places for nurses to work.

“We have all heard that turnover is less, vacancy rates are lower, retention is longer and support is better,” Plank said. “This study does not dispute any of the findings of previous studies.”

Drenkard also voiced concern about elements the researchers evaluated, which are not Magnet measurements.

The authors of the paper acknowledge that, writing, “Magnet journey focuses on structures and processes that do not typically address the work schedules and job demands of nurses.”

Most hospitals now schedule nurses for a 12-hour shift, Trinkoff said. However, some nurses find working that long taxing, and others have childcare or other personal responsibilities that make shorter days more attractive.

“Hospitals could offer other options to people,” said Trinkoff, adding that shorter shifts, such as eight-hour days or a 10 a.m. to 2 p.m. assignment, might bring in nurses who would not otherwise join the workforce.

Nurses and hospitals can take steps to improve the work environment, Trinkoff added. For instance, nurses can turn down overtime and make sure they take breaks. And hospitals should not schedule meetings at the end of the workday. They should provide enough staffing so nurses can eat meals off the unit and leave on time and should not ask nurses to work overtime.

“Nurses need time for sleep and to recover,” Trinkoff said. “Phone calls from work requesting they come back in can be disruptive.”

One explanation for the similarities is that there is nothing stopping non-Magnet hospitals from adopting some of the principles associated with Magnet status without going through the expense and time commitment necessary to achieve the designation.

“As the success of Magnet hospitals have been pointed out, of course others want to emulate that,” Plank said. “Becoming a Magnet hospital is expensive and takes time and energy and effort away from what you are trying to do, which is take care of patients, so some of them may have decided to not go through the steps but still try to be the best they can be.”

Drenkard agreed, adding that one cannot assume that organizations that are not Magnet-recognized do not exhibit Magnet characteristics, which makes it hard to compare.

Trinkoff concurred that non-Magnet hospitals could be adopting some of the evidence-based attributes of Magnet facilities. She urged all hospitals to pay attention to job demands and scheduling, since they contribute to nurses leaving the field.

“We wish all hospitals would think about ways to address conditions to improve work for nurses,” Trinkoff said. “And also to consider that by having alternatives to 12-hour shifts, you can improve the health and performance of nurses and attract others looking for better and healthier schedules and conditions.”